目的 探讨组合检测血清血管生成素2(angiopoietin 2,Ang-2)与克拉拉细胞蛋白16(Clara cell protein 16,CC16)早期诊断急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的临床价值.方法 2015年3月至2016年9月期间入住深圳市宝安区人民医院重症医学科的200例危重病患者纳入研究;根据柏林标准分为ARDS患者100例和非ARDS患者100例,运用酶联免疫吸附测定方法检测每例患者入科首日及次日血清Ang-2和CC16水平,完成APACHEⅡ评分、病史、生命体征采集及其他生化指标检测,并对每项数据进行成组t检验等进行统计分析.结果 入科首日及次日ARDS患者的血清Ang-2与CC16水平明显高于非ARDS患者,并发现在ARDS患者中血清Ang-2与CC16水平之间存在相关性.采用多重受试者工作特征(多重ROC)曲线计算单项及组合检测首日、次日血清Ang-2、CC16水平参考指标的曲线下面积发现,敏感度最高的为首日Ang-2与首日CC16组合检测(敏感度为75.9%);特异度最高的为首日CC16检测(特异度为70.2%).结论 单项检测血清Ang-2与CC16水平均可用于早期诊断ARDS,且组合两项后其敏感性优于单项检测.
Objective To investigate the clinical value of combined detection of serum angiopoietin 2 (Ang-2) and Clara cell protein 16 (CC16) in the early diagnosis of acute respiratory distress syndrome (ARDS).Methods Two hundred critical patients, treated at the Department of Critical Care Medicine, Bao'an District People's Hospital, Shenzhen during March 2015 and September 2016,were included in the study. According to the Berlin standard, patients were divided into two groups (n=100 each group): the ARDS group and non-ARDS group.The serum levels of Ang-2 and CC16 were measured by enzyme-linked immunosorbent assay (ELISA) on the first and second day of admission for each patient, in addition to completing APACHEⅡ score, medical history, vital signs collection and other biochemical indicators detection. Finally, paired-samplest test was used to analyze the data. The multiple ROC curve was used to calculate the area under the curve of the reference index of the serum levels of Ang-2 and CC16 on the first and second day.Results On the first and second day, the serum levels of Ang-2 and CC16 were significantly higher in ARDS patients than those in non-ARDS patients, and there was a correlation between the serum levels of Ang-2 and CC16 in ARDS patients. The ROC curve showed that the combined detection of Ang-2 and CC16 on the first day achieved a highest sensitivity of 75.9% and detection of CC16 on the first day achieved a highest specificity of 70.2%. Conclusion Single-detection of serum levels of Ang-2 and CC16 could be used for early diagnosis of ARDS, and the combined detection of both has a higher sensitivity than single detection.